New Affiliate Chapter Application

New Affiliate Chapter Application

Thank you for your interest in establishing an Affiliate Chapter of Sisters Network Inc.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Are you a Survivor?*

YesNo
Are you in Active Treatment?*

YesNo
Please describe how you heard about Sisters Network Inc*
Why are you interested in establishing an affiliate chapter?*
Briefly describe how you will bring the mission and goal of Sisters Network Inc to life in your community. *
What local contacts and relationships do you have that will help you support a Sisters Network Affiliate Chapter?*
Briefly describe the support you would need from National Headquarters should you become an Affiliate Chapter.*
Proposed Chapter Location *
(City/State)
List 3 Sisters Network Affiliate Chapters closest to your proposed location.*
What percentage of the population in your city identifies as African American? (Tip: Check your city’s official website for demographic data or contact a local elected official’s office for assistance.)*
Please list the ZIP codes that your Affiliate Chapter will serve. (Tip: You can reference a county ZIP code map to identify the areas you plan to cover.)*
Do you have fundraising experience? If so, please provide 2-3 examples. *
Please share some initial ideas on how you plan to fundraise to support your Affiliate Chapter’s activities.*
What are some outreach programs you would like to implement in the community to raise breast cancer awareness?*
Please list your current community service involvement. *
Please attach a headshot and biography (as it relates to breast cancer)*

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New Affiliate Chapter Application

Please List the (5) Executive Members below